Large Vessel Vasculitis

Large Vessel Vasculitis

2019 Phoenix Patient Conference: Large Vessel Vasculitis
Kenneth J. Warrington, MD. Chair, Division of Rheumatology
Mayo Clinic, Rochester, MN

Introduction to today’s topic: large vessel vasculitis. 00:28
Concepts common to all forms of vasculitis, including what is inflammation. 00:40
Signs of inflammation and the role of white blood cells. 01:48
What is a blood vessel and how is it affected by inflammation? 02:26
One of the most feared consequences in giant cell arteritis: loss of vision. 03:18
Description of different blood vessels and their association with organs in the body. 04:12
Vasculitis that affects the large arteries: GCA and Takayasu’s arteritis and how they affect the aorta, brain, eyes, and arms. 04:50
The genetic component of vasculitis. 06:19
Where people are from: increased risk in Northern Europe/Northern European heritage. 07:18
Environmental factors: viruses (shingles), bacteria, other infections and role of smoking. 08:00
Facts about GCA and who’s affected, along with the classic symptoms. 09:48
Symptom overlap of polymyalgia rheumatica and GCA. 12:56
Facts about Takayasu arteritis: who’s affected, symptoms. 13:57
Diagnosing and monitoring large vessel vasculitis: markers of inflammation and testing. 15:47
View of temporal artery ultrasound of normal and abnormal blood vessel. 17:19
Temporal artery biopsy and vascular imaging techniques with scanning (CT, MRI). 18:54
MRA scan and angiogram images, along with MRI scan looking at the normal/abnormal aorta. 21:20
What is a positron emission tomography (PET scan) and why is it needed? 24:19
History lessons: first patient to have a biopsy for GCA, discovery of cortisone in the 1940s to prevent blindness in GCA. 26:27
Phases of treatment: induce remission, remission maintenance, relapses (flares). 27:57
Common principles of treatment: healthy diet and exercise, and infection risk. 29:03
The good side versus the not-so-good side of glucocorticoids. 30:43
Risks and advantages of low dose prednisone and tocilizumab. 32:15
Treatment of Takayasu arteritis: glucocorticoids, immune suppressants, and biologics. 36:02
What is an aortic aneurysm? 36:52
Strategies to reduce disease- and treatment-related damage. 37:39
Questions from audience. 38:32